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General NPI Number Information
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NPI Number | 1710839154
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION THERAPEUTIC WELLNESS CENTER
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 71 ROSETTE ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-2413
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Country | US
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Telephone | 678-268-3221
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Fax |
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Provider Business Mailing Address
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Address Line | 5818 W AMALFI WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3847
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Country | US
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Telephone | 678-268-3221
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Fax | 678-268-3221
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | SHANAE HENLEY
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Credential | HENLEY
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Telephone | 678-268-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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